• Tuberculosis and Respiratory Diseases
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• v.39 no.5
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• pp.392-399
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• 1992

Background: Despite dyspnea is a predominant complaint of patients with respiratory disease, the mechanisms contributing to the sensation of breathlessness are poorly understood. Traditionally, physicians have measured objective pulmonary function to assess severity of dyspnea. But it will be also useful to measure subjective dyspnea index because dyspnea probably depends on a complex interplay of mechanical, experimental, emotional and other factors. Method: We measured breathlessness at rest, after Methacholine challenge and then bronchodilator inhalation using a Visual Analogue Scale (VAS) and Borg Scale Dyspnea Index (BSDI) in stable asthmatic patients. Spirometry was performed concomittently. Results: There was no correlation between dyspnea index and FEV1. There was also no correlation between the change in dyspnea index and change in FEV1. The change in dyspnea index after methacholine and bronchodilator was greater in clinically mild asthmatic patients than clinically severe symptomatic group. Conclusion: In asthmatic patients, there was a wide variation in sensory response for any given FEV1, and the change in perception of dyspnea was greater in those with clinically mild symptoms. The measurement of dyspnea index may yield information complementary to that obtained by spirometry.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.161-166
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• 1985

Endobronchial tuberculosis is frequently associated with lymphadenopathy, bronchial stenosis, atelectasis which needs to be differentiated with other pulmonary disease. Authors are presenting 25 cases of endobronchial tuberculosis which were confirmed by bronchoscopic biopsy and AFB smear and/or culture. The study was done on patients who visited Yeungnam University Hospital from May 1983 to July 1985. The following results were obtained: 1. Of the 25 cases, 8 cases were male and 17 cases were female (male : female= 1 : 2). 32 percent of the cases was older than 60 years of age. 2. Abnormal findings on chest x-ray were seen on 22 cases of 25 cases (88%) and its most predilective site was right upper lobe.(24%). 3. Symptoms were coughing (56%), hemoptysis, hoarseness, chest pain, dyspnea and fever in orders. 4. The positive results were obtained in 73 percent of sputum AFB sme ar (11 cases of 15 cases), 60 percent of AFB culture (3 cases of 5 cases) and 58 percent of bronchoscopic biopsy (14 cases of 24 cases). 5. Complete pulmonary function test was done on 19 cases and showed normal result in 6 cases, restrictive pattern in 8 cases and small airway dysfunction in 5 cases. No case of obstructive airway disease was detected. 6. Associated disease were hypertension (2 cases), tuberculous meningitis (1 case), diabetes mellitus (1 case), and cataract (1 case). 7. The site of bronchoscopic lesion on bronchoscopic examination were as follows; 8. All 25 patients were treated with anti-tuberculosis theyapy and 6 patients were treated with additional steroid therapy because of severe respiratory symptom and showed dramatic improvement of symptom as well as lung function.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.53-64
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• 1999

Background : Massive and untreated hemoptysis is associated with a mortality of greater than 50 percent. Since the bleeding is from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries(BAE) has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of bleeding in 75 to 90 percent of the patients. Methods: Between 1990 and 1996, we treated 146 patients with hemoptysis by bronchial artery embolization. Catheters(4, 5, or 7F) and gelfoam, ivalon, and/or microcoil were used for embolization. Results: Pulmonary tuberculosis and related disorders were the most common underlying disease of hemoptysis(72.6%). Immediate success rate to control bleeding within 24hours was 95%, and recurrence rate was 24.7%. The recurrence rate occured within 6 months after embolization was 63.9%. Initial angiographic findings such as bilaterality, systemic-pulmonary artery shunt, neovascularity, aneurysm were not statistically correlated with rebleeding tendency(P>0.05). Among Initial radiographic findings, only pleural lesions were significantly correlated with rebleeding tendency(P<0.05). At additional bronchial artery angiograpy done due to rebleeding, recanalization of previous embolized arteries were 63.9%, and the presence of new feeding arteries were 16.7%, and 19.4% of patients with rebleeding showed both The complications such as fever, chest pain, headache, nausea and vomiting, arrhythmia, paralylytic ileus, transient sensory loss (lower extremities), hypotension, urination difficulty were noticed at 40 patients(27.4%). Conclusion: We conclude that bronchial artery embolization is relatively safe method achieving immediate control of massive hemoptysis. At initial angiographic findings, we could not find any predictive factors for subsequent rebleeding. It may warrant further study whether patients with pleural disease have definetely increased rebleeding tendency.

• Tuberculosis and Respiratory Diseases
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• v.52 no.1
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• pp.46-53
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• 2002

Background: Pulmonary aspergilloma is relatively common in korea. It arises from the colonization and proliferation of Aspergillus in preexisting lung parenchymal cavities, in particular tuberculosis. The most common symptom in this disorder is hemoptysis, which mayor may not be massive and life threatening. A routine chest radiography and computed tomography (CT) are the most important diagnostic procedures. A surgical resection of the aspergilloma has recently been recommended, because of the relatively low incidence of postoperative complications than in the past. A more concentrated sample of patients with aspergilloma, who either underwent a thoracotomy or tested positive for aspergillus antibodies, were reviewed. Method : The medical records of twenty-two patients with aspergilloma, who had a proven thoracotomy (9 cases), or who tested positive for the diagnostic procedure and/or aspergillus antibodies (13 cases) from January 1995 to December 2000, were reviewed retrospectively. Results : The most common underlying lung disease was a current or old healed tuberculosis, and 3 patients had cultures of mycobacterium other than tuberculosis (MOTT). The mean time until the aspergilloma was detected 5.91 years in the healed tuberculosis cases. The others cases involved a lung abscess, bronchiectasis and without lung disease. The extrapulmonary disease was alcoholism and diabetes. Hemoptysis was most common in 72.7%. A computed tomography (CT) is useful for diagnosis. The right upper lobe, especially the posterior segment, is the most common location. Bronchial artery embolization is ineffective for a long term follow-up. A lobectomy is most common in a thoracotomy, and intra-operative and post-operative complications are rare. During follow-up, the mortality rate, not from the aspergilloma but from respiratory failure, was 13.6%. Conclusion : Aspergilloma is a common cavitary lung disease, It mainly arises from tuberculosis, either current or healed, but extra-pulmonary disease including alcoholism or diabetes are other possible risk factors. Their most common problem in aspergilloma is hemoptysis. Surgery has a low risk of post-operative complications and is recommended in relatively preserved lung function or healthy patients. Medical maneuvers including embolization, and the local insertion of certain materials needs to be studied more closely.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.375-377
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• 2003

Pneumomediastinum, also referred to as mediastinal emphysema or Hamman's syndrome, is defined as the presence of air or gas within the fascial planes of the mediastinum. Superior extension of air into the cervicofacial subcutaneous space via communications between the mediastinum and cervical fascial planes or spaces occurs occasionally, Pneumomediastinum frequently results from blunt tracheobronchial lesions and esophageal injuries. However, in most cases, the origin of pneumomediastinum remains unclear. an some cases, it is attributed to the Macklin effect. We report a case of patient with pneumomediastinum, that presented with Macklin effect on chest computed tomographic scan.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.139-144
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• 2007

Background: Bronchial anthracofibrosis, which is defined as bronchial narrowing with black pigmentation of the overlying bronchial mucosa, is frequently associated with tuberculosis. The aim of this study was to examine the relationship between bronchial anthrocofibrosis and to identify the clinical and radiological characteristics of non-tuberculous bronchial anthracofibrosis. Methods: All patients who showed bronchial anthracofibrosis in more than one segment on a bronchoscopic examination from January 2003 to July 2006 at Kangnam St. Mary's hospital were enrolled in this study. The underlying diseases, baseline clinical characteristics, characteristic findings on a computed tomogram (CT) of the chest, pathologic findings of the bronchial mucosa, and the clinical response to steroid therapy were analyzed retrospectively. Results: A total 54 patients (19 males, 35 females) were enrolled with a mean age of 75 years. The most common presenting symptoms were cough, sputum and dyspnea. The predominant X-ray findings were peribronchial soft tissue attenuation with or without calcification, mediastinal lymphadenopathy with or without calcification and atelectasis. Fourteen non-tuberculous anthracofibrosis patients were treated with steroid. Nine patients were improved clinically, and 6 patients were improved radiologically. Conclusion: Bronchial anthracofibrosis is frequently associated with various pulmonary diseases not only tuberculosis but also COPD pneumonia etc.

• Tuberculosis and Respiratory Diseases
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• v.60 no.3
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• pp.337-341
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• 2006

Objectives : Endobronchial anthracofibrotic pigmentation, which presents as dark black or brown pigmentation mucosal changes of multiple bronchi combined with bronchial fibrosis and obstruction, is not a rare finding when performing diagnostic bronchoscopy for Koreans. This study was performed to define the clinical characteristics and to determine the association of these finding with the Korean life style and such other diseases as coal workers, pneumoconiosis or tuberculosis in the patients with anthracofibrotic pigmentation. Methods : This retrospective analysis was conducted on 70 (5.2%) patients with endobronchial anthracofibrotic pigmentation, among a total of 1340 patients who underwent bronchoscopy. The distinctive clinical features, the personal life style, the past medical history, the histology and microbiology, the radiologic finding and the natures of the bronchoscopic lesions were analyzed. Results : This mean age of the patients with anthracofibrotic pigmentation was $60.6{\pm}9.2$ year old and the male to female ratio was 1:1.7. The common respiratory symptoms of these patients were coughing and sputum (81%, 57/70), and this was followed in order by dyspnea and hemoptysisir. The symptoms were not related with smoking and an occupational history such as being a coal worker and so on. Pneumonia was most common finding on the radiologic studies. On bronchoscopy, the right middle lobe bronchus was most commonly involved. The most common associated disease was tuberculosis, and 40 cases (57.1%) were diagnosed by AFB staining, TB PCR, bronchoscopic guided tissue biopsy and a past history of tuberculosis. Other diseases related with anthracotic pigmentation were hypertension, diabetes, COPD, lung cancer, pneumoconiosis and asthma. Conclusion : These results suggest that endobronchial anthracofibrotic pigmentation was mostly related with pulmonary tuberculosis rather than with coal- related disease. Endobronchial anthracofibrotic pigmentation was more prevalent in older age females in Korea.

• Tuberculosis and Respiratory Diseases
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• v.48 no.1
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• pp.33-44
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• 2000

Background: To evaluate airway responses and inflammation to antigen in Sprague-Dawley rat asthma model, we examined airway responses, serial histologic changes of the lung, and the relationship between airway responses and airway inflammation after antigen airway challenge. Methods: Sprague-Dawley rats were sensitized with subcutaneous injection of 10 ${\mu}g$ ovalbumin(OA). Antigen airway challenges were done 14~16 days after sensitization and the sensitized rats were sacrificed 1h($A_E$), 6~8h($A_L$) and 1day($A_D$) after airway challenge, to examine the histologic changes of the lung. Airway responses were measured by body plethysmograph and recorded by enhanced pause(Penh) as an index of airway obstruction 6~8h after antigen challenges. Nonsensitized controls(10 rats) were also challenged with antigen and sacrificed 1 day later. Histopathologic examination of two trachea, large bronchi, small bronchi, and vessels was performed to evaluate the severity of inflammation and eosinophilic infiltration with H&E stain. Results: In 17 of 20 rats(85%) in both groups, we observed airway responses. Among them, an early response(ER) in 15 rats(75%), an dual response in 5(25%), and an late response(LR) only in 2 rats(10%) displayed. There were no significant differences in the severity of inflammation among the trachea, large bronchi, small bronchi and vessels in all groups after antigen challenge(p>0.05) and between early and late responders. The significant eosinophil infiltration was observed in 5 rats(50%) of AL(p<0.05) compared with in AE and controls. Also, eosinophil infiltration was observed in higher trend in LR(57.1%) compared to ER(40%)(p>0.05). Conclusion: Sprague-Dawley rats sensitized with subcutaneous injection of OA showed a significant airway responses to antigen challenge. But antigen challenges caused a little eosinophil infiltration and no significant airway inflammation. Asthma model of Sprague-Dawley rats could be useful for antigen-induced airway responses, but this model has a limitation for the study of human asthma because of no significant pathologic change.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.533-537
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• 2008

Mycoplasma pneumoniae (M. pneumoniae) infection causes a wide variety of clinical manifestations in children and young adults, the main one being pneumonia. M. pneumoniae is transmitted from person to person by infected respiratory droplets. Symptoms caused by M. pneumoniae infection can be divided into those involving the respiratory tract, and those caused by extrapulmonary disease. M. pneumoniae infections may cause central nervous system (CNS) complications-with encephalitis being the most frequent-and stroke being a rare complication. The pathogenesis of the CNS disease is unclear; possibilities include direct infection and an immune-mediated reaction. We present two cases of CNS complications subsequent to infection with M. pneumoniae; both cases had convincing evidence of preceding M. pneumoniae respiratory disease with no evidence of viable M. pneumoniae in the cerebrospinal fluid. We report cases of encephalitis and stroke following a recent M. pneumoniae infection.

• Tuberculosis and Respiratory Diseases
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• v.49 no.3
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• pp.372-375
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• 2000

Spinal epidural emphysema is rare, and only a few cases have ever been reported. A 18 year-old man was admitted for neck and chest pain for 3 days. Before admission he experienced rhinorrhea and severe cough. Physical examination revealed wheezing on whole lung field and subcutaneous emphysema over the upper portion of the chest and neck. Chest radiograph showed pneumomediastinum and subcutaneous emphysema in the neck and chest CT images demonstrate a free air in the prevertebral fascia. With conservative management, the patient's condition and the pneumomediastinum improved. The patient was discharged to home on the fourteenth day.